MEDICARE: SEAN ESCHENBACH, DDS, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1255103198
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEAN ESCHENBACH, DDS, PLLC

Provider Business Mailing Address
First Line	:	6027 PETERS CREEK RD
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24019-4029
Country	:	US
Telephone Number	:	540-366-5373
Fax Number	:

Provider Business Practice Location Address
First Line	:	6027 PETERS CREEK RD
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24019-4029
Country	:	US
Telephone Number	:	540-366-5373
Fax Number	:

Authorized Official
Title or Position	:	DENTIST/PRESIDENT
Name	:	DR. SEAN LEON ESCHENBACH
Credential	:	DDS
Telephone Number	:	540-366-5373

Provider Enumeration Date	:	10/24/2023
Last Update Date	:	10/24/2023

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